| Name: | Lakeview Ocean State, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Corporation |
| Status: | Withdrawn |
| Date of Organization in Rhode Island: | 24 Oct 2005 (19 years ago) |
| Date of Dissolution: | 30 Mar 2012 (13 years ago) |
| Date of Status Change: | 30 Mar 2012 (13 years ago) |
| Identification Number: | 000151427 |
| ZIP code: | 02903 |
| County: | Providence County |
| Place of Formation: | DELAWARE |
| Principal Address: | C/O MENTOR ABI LLC 313 CONGRESS ST. 5TH FLOOR, BOSTON, MA, 02210, USA |
| Mailing Address: | CT CORPORATION SYSTEM 10 WEYBOSSET STREET, PROVIDENCE, RI, 02903, USA |
| Purpose: | HEALTH AND HUMAN SERVICES |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023140415 | 2007-03-12 | 2009-07-09 | 244 HIGH WATCH RD, EFFINGHAM, NH, 038828336, US | 4219 S COUNTY TRL, CHARLESTOWN, RI, 028133628, US | |||||||||||||||||||||
|
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| Phone | +1 603-539-7451 |
| Phone | +1 401-364-8719 |
Authorized person
| Name | CHRIS SLOVER |
| Role | ADMINISTRATOR |
| Phone | 6035397451 |
Taxonomy
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | LO58163 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 10 WEYBOSSET STREET, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| BRUCE F. NARDELLA | PRESIDENT | 313 CONGRESS ST. BOSTON, MA 02210 USA |
| Name | Role | Address |
|---|---|---|
| DENIS M. HOLLER | TREASURER | 313 CONGRESS ST. BOSTON, MA 02210 USA |
| Name | Role | Address |
|---|---|---|
| LINDA DERENZO | SECRETARY | 313 CONGRESS ST. BOSTON, MA 02210 USA |
| Name | Role | Address |
|---|---|---|
| SARAH E. IDELSON | ASSISTANT SECRETARY | 313 CONGRESS ST. BOSTON, MA 02210 USA |
| Name | Role | Address |
|---|---|---|
| DENIS M. HOLLER | DIRECTOR | 313 CONGRESS ST. BOSTON, MA 02210 USA |
| EDWARD M. MURPHY | DIRECTOR | 313 CONGRESS ST. BOSTON, MA 02210 USA |
| BRUCE F. NARDELLA | DIRECTOR | 313 CONGRESS ST. BOSTON, MA 02210 USA |
| Number | Name | File Date |
|---|---|---|
| 201291437960 | Application for Certificate of Withdrawal | 2012-03-27 |
| 201288966510 | Annual Report - Amended | 2012-02-03 |
| 201288548860 | Annual Report | 2012-01-26 |
| 201178596180 | Statement of Change of Registered/Resident Agent Office | 2011-05-02 |
| 201175850690 | Annual Report | 2011-03-01 |
| 201059438990 | Annual Report | 2010-02-25 |
| 200943181790 | Annual Report | 2009-02-28 |
| 200838974300 | Statement of Change of Registered/Resident Agent Office | 2008-12-04 |
| 200808721660 | Annual Report | 2008-03-31 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
